Legal and Socio-Economic Challenges Posed by P4 Medicine and AI

1. Start accumulating and listing potential footnotes, citing the materials you have used.
a. Completed (5 footnotes so far)
2. Investigate and report on whether the WHO or other international agencies and organizations
have developed any guidelines or procedures along the lines of what you have discussed and
proposed.
a. No international organizations/agencies have a guideline or a procedure for P4 medicine.
This may be due to the fact that P4 medicine is a relatively new concept for the
organizations to develop procedures and guidelines. (The term was coined in 2003 by
Leroy Hood)
3. The same investigation on the regional, national and local levels, including any adoption of
international standards or procedures at those levels.
a. Because all organizations did not have guidelines or procedures for P4 medicine at all, I
could not find those in national, local, and regional levels.
4. Have any of the potential problems you describe developed already?
a. There are economic and social inequalities already present in America.
https://www.jstor.org/stable/10.1525/j.ctt1kc6k1p.23?seq=1#metadata_info_tab_conte
nts
5. Have any of the advantages been recognized already?
a. http://www.esprevmed.org/p4-medicine/
b. https://www.atsjournals.org/doi/10.1513/AnnalsATS.201604-235PS#_i28
c. https://err.ersjournals.com/content/27/147/170110
d. There are numerous research papers that discuss potential benefits of P4 medicine.
6. Have any of the problems come up already?
a. This question is similar to question 4, so I won’t discuss it.

Procedures:
1. Development of P4 medicine technology to an acceptable degree.
a. This step must be addressed by the developers of the technology. Then, it should be
verified of its efficacy by experts in the field and the UN.
2. Propose international standards, practices, and procedures of P4 medicine to the UN’s
Sustainable Development Goals and Agenda 2030.
a. P4 medicine would fall under the goal three of the UN’s Sustainable Development
Goals, Good Health and Well-Being.
i. Employing P4 medicine at cheap costs would help people in the world get
better personalized treatment for their health.
b. P4 medicine proposal will potentially be reviewed as part of the High-level political
forums (HLPF) and the Voluntary National Reviews (VNRs).
c. The proposal should include: a plan to make the technology available all around the
world, a procedure that describes the process of P4 medicine, and answers that
address potential concerns.
 i. Potential Concerns and answers to address them are written below. Note that
they do not represent the entirety of the concerns, and that more concerns
may emerge as the plan progresses.
ii. If P4 medicine is used with AI, potential concerns should also be addressed;
They are below the “P4 medicine” section.
3. After approval, the use of P4 medicine for the public should be lowered in costs before
implementing in countries.
a. By getting public health funds or public sectors.
b. By further developing the technology.
c. By getting investments.
d. By getting special taxes from those who use P4 medicine.
e. Other possibilities may emerge.
4. Implementation of the technology to the world, advertised and supported by respective
governments.
a. This will have to be dealt with each individual countries to promote P4 medicine and
AI.
5. Take future actions to address potential problems that arise from practicing P4 medicine and
AI.
a. A group of people, perhaps government officials, should continue to observe the new
technology’s effect on the world and address concerns that arise from it.

P4 Medicine
Proposing international standards, practices, and procedures of P4 medicine to the UN.
Given P4 medicine’s scientific importance and possible ramifications it could bring, countries in
the world must follow the same rules to ensure the success and safety of the implementation of P4
medicine. One way to do this is to include this proposal into the UN's Sustainable Development Goals
and Agenda 2030, potentially getting reviewed as part of the High-level political forums (HLPF)1 and the
Voluntary National Reviews (VNRs)2. There are mainly two levels in which the challenges arise of
implementing P4 medicine, national and local. Nationally, P4 medicine must prove its efficacy and
beneficiality to world’s leaders. That is a scientific concern and must be addressed by the developers of
the technology to ensure the acceptance of P4 medicine in the world. After that, many social and
economic concerns arise from implementing P4 medicine at the local level. First, the cost of
implementation should be considered. Given that P4 medicine technology operates by “scanning” each
individual person’s genomic data and analyzing it, time is required before the expensive costs of
prototype P4 medicine “scanners” are dropped. In addition, even if the cost of using P4 medicine is
reasonable, there is a concern among the public because new technology inevitably brings the fear of
the unknown. In order to address this issue, each country may do government-funded advertisements to
demonstrate the efficacy and the safety of using P4 medicine, which is plausible to work because of the
credibility of governments. Even then, there are many details that should be considered thoroughly, such

1
https://sustainabledevelopment.un.org/hlpf
2
https://sustainabledevelopment.un.org/vnrs/
as the method of storing billions of patients’ genomic medical data. Below are some of the concerns P4
medicine may bring.

Unless enough persons are willing to share their experience, data will be insufficient to verify efficacity,
hence, offer therapeutic or preventive benefits widely enough;
To promote the benefits of utilizing P4 medicine in healthcare, there are chiefly two ways to
spread the medicine: person-to-person or advertising. In the case of the former, it is not dependable
because the willingness of individual patients to share their experience with P4 medicine may vary.
However, advertising, especially government-funded, can have a profound effect on popularizing P4
medicine. With the ethos of the government, people would at least try P4 medicine and either be
disappointed with it or content with it. Hence, it is crucial that the efficacy of P4 medicine itself is
profound and unparalleled with previously used medicine. With the government-funded advertisement
and the supreme efficacy of P4 medicine, the synergy gained will boost the popularity of P4 medicine to
make it available throughout the entire country.

Will it lead to even more economic and social inequalities, favoring access to the rich and better
connected?
It has been suggested that P4 medicine will lead to a more cost-effective hospital care for the
patients3. Indeed, personalized treatment will be specific and succinct to minimize the cost of health
treatment. However, the question of the availability of P4 medicine should be considered. While the use
of P4 medicine reduces the health costs, the initial “scanning” may be expensive to some people,
because one has to be scanned of everything in one’s body, from genes to organs. The poor may not be
able to comply with the high costs of scanning, and it would lead to further economic and social
inequalities. Since the rich can afford to be scanned, they would enjoy the low-cost implementation of
P4 medicine in the future. This contradicts the very motive of using P4 medicine because it poses an
initial economic barrier to those who cannot afford to scan and thus only favoring the rich. If P4
medicine is meant to be readily available for all, the cost of “scanning” should be minimized.

Should public health funds be used for this R & R or only money from the public sector?
The discussion of the implementation of P4 medicine gives a rise to a question: how will the
system be financed? One significant way to finance P4 medicine would be government funding, but
whether public health funds be used is an important question to consider. In order to successfully
implement P4 medicine into people’s lives, two steps must be taken. One, the establishment of the
“scanning” equipment and procedures to gather data of each individual patient’s health information.
Two, diagnosing and prescribing medication to patients. The first step can be through government
funding since high-tech pieces of equipment necessary for P4 medicine scanning is expensive. The
second step can be covered by public health funds financially assisting a portion of costs for diagnosing
and prescribing. Should public health funds cover for the pricey equipment, only a few selected places
would get to implement P4 medicine because public health funds are financially limited. In conclusion,
government funding and public health funds should be used together to successfully alleviate the
financial problems of implementing P4 medicine.

3
(Flores et al., 2012) https://pubmed.ncbi.nlm.nih.gov/22450380/
Will P4 medicine eliminate the need for general, widespread medicines such as Tylenol, Advil, and
Aspirin?
P4 medicine was designed to provide specialized treatment according to each individual
patients’ health data. This means that it would minimize the need for general, widely-used medicines
such as Tylenol, Advil, and Aspirin. For example, a patient could experience a headache and decide to
take medicine. If the patient is using P4 medicine, there is no need to take Advil, because a specialized
medicine for the patient is more beneficial and effective. However, that does not mean that the need for
general medicine diminishes completely. For mild symptoms, medicine like Advil helps to soothe general
pain. However, when the pain gets more serious, an intervention of P4 medicine may be necessary. In
conclusion, although P4 medicine will replace general medicines for more serious symptoms, general
medicines will still be used for milder symptoms.

Could patients’ personalized health data gathered be misused?

P4 medicine has its basis in gathering each individual patient’s health data and providing
specialized treatment. Unsurprisingly, the data is extremely personal and valuable, which, if misused,
could make a big impact. In order to protect the patients’ health data, two significant acts have been
enacted in the past: The Health Insurance Portability and Accountability Act of 1996 (HIPAA)4 and the
Genetic Information Nondiscrimination Act of 2008 (GINA)5. HIPAA is a federal law that requires the
protection of sensitive patient health information from being disclosed with the patient’s consent or
knowledge. GINA prohibits genetic information discrimination in employment, such as letting genetic
information influence whether one should be employed. These laws would protect P4 medicine patients’
personal health data, but the laws do not completely cover the ground needed for absolute protection of
data. For example, anyone with access to the patients’ data could spread the data, even if the law forbids
it. Even though the law may punish those who misuse patients’ data, the data has already gone out to
the public and cannot be retracted. In order to prevent this, access to a patient’s health data should only
be accessible to the patient. In conclusion, P4 medicine poses vulnerability to the misuse of personal
health data, and future laws prohibiting the access of data to people other than the patient should be
considered to guarantee safety for the patient.

AI
Is AI too insensitive or without a moral and ethical compass to be empowered to play a major role in
decision-making, like who can get treatment and who cannot?
Because AI makes judgments based without any emotions, its judgments will not be swayed by
sentimental information. This type of behavior with AI has a positive effect and a negative effect. Since
the AI does not take morals or ethical compass to account, it will be useful to maintain consistency in
deciding important matters, such as who can get treatment and who cannot. However, because it is so
strict, it may not be effective in special situations, such as when a poor patient is on the verge of death
and the AI decides that the patient does not get treatment. In order to address this issue, AI must be

4
https://www.cdc.gov/phlp/publications/topic/hipaa.html
5
https://www.eeoc.gov/statutes/genetic-information-nondiscrimination-act-2008
designed so that it can be overridden by authorized people. This privilege of overriding the AI must be
kept within a small number of people, because abusing it may result in inconsistent judgments. In
summary, unless AI is equipped with morals, an absolute power of decision making should not be
granted to AIs and there should be authorized people to keep AIs in check.

Is AI trustworthy to manage important tasks? For example, is there a possibility of hacking into the AI
and manipulating the vast amount of data it holds?
Since AIs are digital, there is always a possibility of hacking into them. There are no certain ways
to completely prevent AIs from being hacked, and this necessitates triggering further actions when AIs
are hacked. For example, the data held in AIs could be destroyed or transferred to a different location
when they are hacked. Nevertheless, given the importance of AIs and their data, a vast number of
protective means should be applied to the highest priority.

Are there ways to control AIs in case they get out of control?
Because AIs, deriving from their name, can think and make decisions on their own, there is a
possibility of unexpected behaviors. In such cases, it is crucial to control AIs and reset them, if needed. To
accomplish that task, programmers should always leave a backup plan to control the AIs. Few potential
ways are hacking the AI, deleting the AI, or resetting the AI. Given the current stage of the development
of AIs, there are not yet highly conscious AIs. However, we should ponder and consider the ramifications
uncontrolled AIs may bring and strive to find a solution.